Pelvic prolapse. This is when your bladder, urethra, or rectum slide into the vagina. Delivering a baby can cause nerve or tissue damage in the pelvic area. This can lead to pelvic prolapse months or years after delivery.

Symptoms

The main symptom of stress incontinence is leaking urine when you:

Are physically active

Cough or sneeze

Exercise

Stand from a sitting or lying down position

Exams and Tests

Your health care provider will perform a physical exam. This will include:

Genital exam in men

Pelvic exam in women

Rectal exam

Tests may include:

Cystoscopy to look inside the bladder.

Pad weight test: You exercise while wearing a sanitary pad. Then the pad is weighed to find out how much urine you lost.

Treatment

Treatment depends on how your symptoms affect your life.

There are 3 types of treatment for stress incontinence:

Bladder training

Pelvic floor muscle training

Surgery

There are no medicines for treatment of stress incontinence. Some health care providers may prescribe a medicine called duloxetine. This medicine is not approved by FDA for the treatment of stress incontinence.

BEHAVIOR CHANGES

Making these changes may help:

Drink less fluid (if you drink more than normal amounts of fluid). Avoid drinking water before going to bed.

Avoid jumping or running.

Take fiber to avoid constipation, which can make urinary incontinence worse.

Avoid alcohol and caffeinated drinks such as coffee. They can make your bladder fill up quicker.

Lose excess weight.

Avoid foods and drinks that may irritate your bladder. These include spicy foods, carbonated drinks, and citrus.

If you have diabetes, keep your blood sugar under good control.

BLADDER TRAINING

Bladder training may help you control your bladder. The person is asked to urinate at regular intervals. Slowly, the time interval is increased. This causes the bladder to stretch and hold more urine.

PELVIC FLOOR MUSCLE TRAINING

There are different ways to strengthen the muscles in your pelvic floor.

Biofeedback: This method can help you learn to identify and control your pelvic floor muscles.

Kegel exercises: These exercises can help keep the muscle around your urethra strong and working well. This may help keep you from leaking urine.

Vaginal cones: You place the cone into the vagina. Then you try to squeeze your pelvic floor muscles to hold the cone in place. You can wear the cone for up to 15 minutes at a time, two times a day. You may notice improvement in your symptoms in 4 to 6 weeks.

Pelvic floor physical therapy: Physical therapists specially trained in the area can fully evaluate the problem and help with exercises and therapies.

SURGERIES

If other treatments do not work, your provider may suggest surgery. Surgery may help if you have bothersome stress incontinence. Most providers suggest surgery only after trying conservative treatments.

Anterior vaginal repair helps restore weak and sagging vaginal walls. This is used when the bladder bulges into the vagina (prolapse). Prolapse may be associated with stress urinary incontinence.

If you have trouble completely emptying your bladder, you may need to use a catheter. This is a very small tube you place in your urethra to drain urine from your bladder.

Outlook (Prognosis)

Getting better takes time, so try to be patient. Symptoms most often get better with nonsurgical treatments. However, they will not cure stress incontinence. Surgery can cure some people of stress incontinence.

Treatment does not work as well if you have:

Conditions that prevent healing or make surgery more difficult

Other genital or urinary problems

Past surgery that did not work

Poorly controlled diabetes

Neurologic disease

Previous radiation to the pelvis

Possible Complications

Physical complications are rare and most often mild. They can include:

Irritation of the vagina lips (vulva)

Skin sores or pressure ulcers in people who have incontinence and can't get out of the bed or chair

Unpleasant odors

Urinary tract infections

The condition may get in the way of social activities, careers, and relationships. It also may lead to:

Embarrassment

Isolation

Depression or anxiety

Loss of productivity at work

Loss of interest in sexual activity

Sleep disturbances

Complications associated with surgery include:

Fistulas or abscesses

Bleeding

Infection

Pain during intercourse

Sexual dysfunction

Wearing away of materials placed during surgery, such as a sling or artificial sphincter

When to Contact a Medical Professional

Call your provider if you have symptoms of stress incontinence and they bother you.

Prevention

Doing Kegel exercises may help prevent symptoms. Women may want to do Kegels during and after pregnancy to help prevent incontinence.